探讨三维可视化技术在腹腔镜解剖性肝切除治疗Ⅰ型肝胆管结石病中的应用价值。

回顾性分析2017年6月至2020年3月在湘西自治州人民医院诊治的33例Ⅰ型肝胆管结石病患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男14例，女19例；年龄26~71岁，中位年龄49岁。根据术前肝动脉、门静脉、肝静脉及胆管三维重建模型，进行术前仿真手术，规划出最佳手术方案。结合术中超声导航，对患者实施腹腔镜解剖性肝切除术。观察患者围手术期情况。

本组33例患者三维重建图像均可清晰显示肝内一、二、三级胆管树立体形态，结石的大小、数量、分布，狭窄或扩张胆管范围，以及门静脉、肝静脉、肝动脉及其分支。术中所见与术前三维重建图像的符合率达100%（33/33），术中实施手术与手术规划符合率达100%（33/33）。患者均顺利完成腹腔镜肝切除术，无中转开腹。其中左半肝切除10例，左外叶切除8例，右半肝切除3例，右前叶切除1例，右后叶切除5例，肝段或联合肝段切除6例。平均手术时间（208±61）min，术中出血量（284±68）ml，术中无输血。术后住院时间（11±4）d。术后无死亡。术后发生并发症3例，其中1例肝断面积液，1例胃排空障碍，1例术后反应性右侧胸腔中量积液，均经保守治疗后治愈。患者术后2个月行T管造影检查，均无结石残留和胆管狭窄，且无胆管炎复发表现。

三维可视化技术有助于Ⅰ型肝胆管结石病患者实施精准腹腔镜肝切除，在实现取尽结石、祛除病灶、解除狭窄、通畅引流的同时，减少并发症的发生。

To evaluate the application value of three-dimensional visualization in laparoscopic anatomical hepatectomy for type Ⅰ hepatolithiasis.

Clinical data of 33 patients with type Ⅰ hepatolithiasis admitted to Xiangxi Autonomous Prefecture People's Hospital from June 2017 to March 2020 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 14 patients were male and 19 female, aged from 26 to 71 years, with a median age of 49 years. According to the preoperative CT three-dimensional reconstruction model of hepatic artery, portal vein, hepatic vein and bile duct, preoperative simulated surgery was performed, and the optimal surgical plan was determined. Combined with the intraoperative ultrasound navigation, laparoscopic anatomical hepatectomy was performed. Perioperative conditions were observed.

Three-dimensional reconstruction images could clearly display the morphology of the first, second, third hepatic bile ducts, and the size, quantity distribution of stones, the range of narrowed or dilated bile ducts, portal vein, hepatic vein, hepatic artery and its branches of patients. The consistency rate between intraoperative findings and preoperative three-dimensional reconstruction images was 100%(33/33), and the consistency rate between intraoperative procedures and surgical plan was 100%(33/33). All the patients successfully completed laparoscopic hepatectomy, and no patient was converted to open surgery. Among them, left hemihepatectomy was performed in 10 cases, left lateral lobectomy in 8, right hemihepatectomy in 3, right anterior lobectomy in 1, right posterior lobectomy in 5 and segmental or combined segmental resection in 6, respectively. The average operation time was (208±61) min, intraoperative blood loss was (284±68) ml, and no blood transfusion was delivered. The length of postoperative hospital stay was (11±4) d.No patient died after operation. Postoperative complications occurred in 3 patients, including 1 case of hepatic effusion, 1 case of gastric emptying disorder and 1 case of reactive right pleural effusion, which were cured after conservative treatments. T-tube angiography at postoperative 2 months detected no residual stone or bile duct stenosis, and no recurrence of cholangitis.

Three-dimensional visualization can help to perform precise laparoscopic hepatectomy in patients with type Ⅰ hepatolithiasis, which can completely remove the stones and lesions, mitigate the stenosis, drain unobstructed, and reduce the incidence of complications.